Gastric Antral Mucosal Changes in Children With Intestinal Metaplasia

Abstract

Objectives: The gastric mucosal change accompanying gastric antral intestinal metaplasia (IM) in the pediatric population and its clinical implications remain unclear. Methods: We retrieved all patients younger than 18 years who had upper GI endoscopy with a pathology diagnosis of antral IM between 2009 and 2020. Each biopsy was evaluated for the presence of dysplasia, Helicobacter pylori, gastritis, and other pathologic changes. Results: A total of 134 patients with antral IM were identified; 72 (53.7%) with coexisting pathology including chronic gastritis (n = 22), reactive gastropathy (n = 16), focal mild chronic inflammation (n = 13), gastric eosinophilia (n = 9), chronic active gastritis associated with (n = 2) and without Helicobacter infection (n = 3), and others (n = 7). The remaining 62 (46.3%) showed isolated IM. Gastric IM increased with age, and was often accompanied by other pathologic changes, especially in female children. Twenty-seven patients had follow up biopsies; 11 of the 27 patients (40.7%) showed persistent IM in at least one repeat biopsies. None demonstrated dysplasia. Conclusions: In children, antral IM increases with age and often coexists with other pathologic changes. Gastric IM could persist for at least months to years in a significant subset of patients with chronic gastritis and gastric eosinophilia.

Gastric Intestinal Metaplasia in Children: Natural History and Clinicopathological Correlation

“…Consistent with our findings, a recent pediatric meta‐analysis and systematic review found a low GIM frequency of 1.2% in antral biopsies and 0.9% in corpus biopsies (27). Another recent study identified a 0.75% frequency of GIM in antral biopsies in children (19). We did not observe reactive gastropathy or GA in our GIM patients.…”

“…Similarly, most of the published pediatric series have found GIM in association with H pylori infection (17,30,35–37). A recent estimate of GIM frequency in H pylori ‐infected children was 2.5% and 1.5% in antral and corpus biopsies, respectively (19,20,27). The number of patients with evidence of H pylori in gastric biopsies in our series was low, making it difficult to draw conclusions.…”

“…We did not observe reactive gastropathy or GA in our GIM patients. However, previously published studies have demonstrated the presence of reactive gastropathy in approximately 12% of pediatric patients with GIM (19,28). Sampling error is a possible reason for the low frequency of GIM, as GIM can be patchy and its detection depends on the numbers and location of biopsy samples.…”

“…are limited in the pediatric population. The few studies available include a small number of children, with fewer studies reporting on findings in children in the US (15)(16)(17)(18)(19)(20). Thus, GIM is difficult to interpret in the clinical setting, with no current agreement on the best management strategy.…”